Editing Psychosis (section)

=== Psychoactive drugs ===
{{Main|Substance-induced psychosis}}

Various [[psychoactive substances]] (both legal and illegal) have been implicated in causing, exacerbating, or precipitating psychotic states or disorders in users, with varying levels of evidence.<ref>{{Cite journal |last1=Baldaçara |first1=Leonardo |last2=Ramos |first2=Artur |last3=Castaldelli-Maia |first3=João Maurício |date=2023 |title=Managing drug-induced psychosis |url=https://pubmed.ncbi.nlm.nih.gov/38299647 |journal=International Review of Psychiatry |volume=35 |issue=5–6 |pages=496–502 |doi=10.1080/09540261.2023.2261544 |issn=1369-1627 |pmid=38299647}}</ref> This may be upon intoxication for a more prolonged period after use, or upon [[drug withdrawal|withdrawal]].<ref name="Cardinal_2011_diagnosis_psychosis" /> Individuals who experience substance-induced psychosis tend to have a greater awareness of their psychosis and tend to have higher levels of [[suicidal thinking]] compared to those who have a primary psychotic illness.<ref name="pmid21728034">{{cite journal | vauthors = Grant KM, LeVan TD, Wells SM, Li M, Stoltenberg SF, Gendelman HE, Carlo G, Bevins RA | display-authors = 6 | title = Methamphetamine-associated psychosis | journal = Journal of Neuroimmune Pharmacology | volume = 7 | issue = 1 | pages = 113–139 | date = March 2012 | pmid = 21728034 | pmc = 3280383 | doi = 10.1007/s11481-011-9288-1 | author6-link = Howard E. Gendelman }}</ref> Drugs commonly alleged to induce psychotic symptoms include [[Alcohol (drug)|alcohol]], [[Cannabis (drug)|cannabis]], [[cocaine]], [[amphetamine]]s, [[cathinone]]s, [[psychedelic drug]]s (such as [[LSD]] and [[psilocybin]]), [[κ-opioid receptor]] [[agonist]]s (such as [[enadoline]] and [[salvinorin A]]) and [[NMDA receptor antagonist]]s (such as [[phencyclidine]] and [[ketamine]]).<ref name="Cardinal_2011_diagnosis_psychosis" /><ref>{{cite journal | vauthors = Krebs TS, Johansen PØ | title = Psychedelics and mental health: a population study | journal = PLOS ONE | volume = 8 | issue = 8 | pages = e63972 | date = August 2013 | pmid = 23976938 | pmc = 3747247 | doi = 10.1371/journal.pone.0063972 | doi-access = free | bibcode = 2013PLoSO...863972K }}</ref> [[Caffeine]] may worsen symptoms in those with schizophrenia and cause psychosis at very high doses in people without the condition.<ref>{{cite journal | vauthors = Alasmari F | title = Caffeine induces neurobehavioral effects through modulating neurotransmitters | journal = Saudi Pharmaceutical Journal | volume = 28 | issue = 4 | pages = 445–451 | date = April 2020 | pmid = 32273803 | pmc = 7132598 | doi = 10.1016/j.jsps.2020.02.005 }}</ref><ref>{{Cite journal | vauthors = Beauchamp G, Amaducci A, Cook M |date=2017-09-01|title=Caffeine Toxicity: A Brief Review and Update |journal=Clinical Pediatric Emergency Medicine|series=Toxicology|language=en|volume=18|issue=3|pages=197–202|doi=10.1016/j.cpem.2017.07.002|issn=1522-8401}}</ref> Cannabis and other illicit recreational drugs are often associated with psychosis in adolescents and cannabis use before 15 years old may increase the risk of psychosis in adulthood.<ref name=":3" />

==== Alcohol ====
{{Further|Long-term effects of alcohol consumption#Mental health effects}}
Approximately three percent of people with [[alcoholism]] experience psychosis during acute intoxication or withdrawal. Alcohol related psychosis may manifest itself through a [[kindling (sedative-hypnotic withdrawal)|kindling mechanism]]. The mechanism of alcohol-related psychosis is due to the [[long-term effects of alcohol consumption]] resulting in distortions to neuronal membranes, [[gene expression]], as well as [[thiamine]] deficiency. It is possible that hazardous alcohol use via a kindling mechanism can cause the development of a chronic substance-induced psychotic disorder, i.e. schizophrenia. The effects of an alcohol-related psychosis include an increased risk of depression and suicide as well as causing psychosocial impairments.<ref>{{cite journal | vauthors = Castillo-Carniglia A, Keyes KM, Hasin DS, Cerdá M | title = Psychiatric comorbidities in alcohol use disorder | journal = The Lancet. Psychiatry | volume = 6 | issue = 12 | pages = 1068–1080 | date = December 2019 | pmid = 31630984 | pmc = 7006178 | doi = 10.1016/S2215-0366(19)30222-6 }}</ref> [[Delirium tremens]], a symptom of chronic alcoholism that can appear in the acute withdrawal phase, shares many symptoms with alcohol-related psychosis suggesting a common mechanism.<ref>{{cite journal | vauthors = Jordaan GP, Emsley R | title = Alcohol-induced psychotic disorder: a review | journal = Metabolic Brain Disease | volume = 29 | issue = 2 | pages = 231–243 | date = June 2014 | pmid = 24307180 | doi = 10.1007/s11011-013-9457-4 | url = http://link.springer.com/10.1007/s11011-013-9457-4 | access-date = 2021-01-20 | url-status = live | s2cid = 17239167 | archive-url = https://web.archive.org/web/20211018155817/https://link.springer.com/article/10.1007%2Fs11011-013-9457-4 | archive-date = 2021-10-18 }}</ref>

==== Cannabis ====
{{Further|Causes of schizophrenia#Cannabis|Long-term effects of cannabis#Chronic psychosis and schizophrenia spectrum disorders}}
According to current studies, cannabis use is associated with increased risk of psychotic disorders, and the more often cannabis is used the more likely a person is to develop a psychotic illness.<ref name=":8">{{cite journal | vauthors = Hasan A, von Keller R, Friemel CM, Hall W, Schneider M, Koethe D, Leweke FM, Strube W, Hoch E | display-authors = 6 | title = Cannabis use and psychosis: a review of reviews | journal = European Archives of Psychiatry and Clinical Neuroscience | volume = 270 | issue = 4 | pages = 403–412 | date = June 2020 | pmid = 31563981 | doi = 10.1007/s00406-019-01068-z | s2cid = 203567900 }}</ref> Furthermore, people with a history of cannabis use develop psychotic symptoms earlier than those who have never used cannabis.<ref name=":8" /> Some debate exists regarding the causal relationship between cannabis use and psychosis with some studies suggesting that cannabis use hastens the onset of psychosis primarily in those with pre-existing vulnerability.<ref name=":8" /><ref>{{cite journal | vauthors = Ortiz-Medina MB, Perea M, Torales J, Ventriglio A, Vitrani G, Aguilar L, Roncero C | title = Cannabis consumption and psychosis or schizophrenia development | journal = The International Journal of Social Psychiatry | volume = 64 | issue = 7 | pages = 690–704 | date = November 2018 | pmid = 30442059 | doi = 10.1177/0020764018801690 | s2cid = 53563635 }}</ref><ref>{{cite journal | vauthors = Hamilton I, Monaghan M | title = Cannabis and Psychosis: Are We any Closer to Understanding the Relationship? | journal = Current Psychiatry Reports | volume = 21 | issue = 7 | pages = 48 | date = June 2019 | pmid = 31161275 | pmc = 6546656 | doi = 10.1007/s11920-019-1044-x }}</ref> Indeed, cannabis use plays an important role in the development of psychosis in vulnerable individuals, and cannabis use in adolescence should be discouraged.<ref>{{cite journal | vauthors = van der Steur SJ, Batalla A, Bossong MG | title = Factors Moderating the Association Between Cannabis Use and Psychosis Risk: A Systematic Review | journal = Brain Sciences | volume = 10 | issue = 2 | pages = 97 | date = February 2020 | pmid = 32059350 | pmc = 7071602 | doi = 10.3390/brainsci10020097 | doi-access = free }}</ref> Some studies indicate that the effects of two active compounds in cannabis, [[tetrahydrocannabinol]] (THC) and [[cannabidiol]] (CBD), have opposite effects with respect to psychosis. While THC can induce psychotic symptoms in healthy individuals, limited evidence suggests that CBD may have antipsychotic effects.<ref>{{cite journal | vauthors = Chesney E, Oliver D, McGuire P | title = Cannabidiol (CBD) as a novel treatment in the early phases of psychosis | journal = Psychopharmacology | date = July 2021 | volume = 239 | issue = 5 | pages = 1179–1190 | pmid = 34255100 | doi = 10.1007/s00213-021-05905-9 | pmc = 9110455 | s2cid = 235807339 }}</ref>

==== Methamphetamine ====
{{Main|Stimulant psychosis}}

[[Methamphetamine]] induces a psychosis in 26–46 percent of heavy users. Some of these people develop a long-lasting psychosis that can persist for longer than six months. Those who have had a short-lived psychosis from methamphetamine can have a relapse of the methamphetamine psychosis years later after a stressful event such as severe insomnia or a period of hazardous alcohol use despite not relapsing back to methamphetamine.<ref>{{cite journal | vauthors = Shin EJ, Dang DK, Tran TV, Tran HQ, Jeong JH, Nah SY, Jang CG, Yamada K, Nabeshima T, Kim HC | display-authors = 6 | title = Current understanding of methamphetamine-associated dopaminergic neurodegeneration and psychotoxic behaviors | journal = Archives of Pharmacal Research | volume = 40 | issue = 4 | pages = 403–428 | date = April 2017 | pmid = 28243833 | doi = 10.1007/s12272-017-0897-y | s2cid = 22791168 }}</ref> Individuals who have a long history of methamphetamine use and who have experienced psychosis in the past from methamphetamine use are highly likely to re-experience methamphetamine psychosis if drug use is recommenced. {{citation needed|date=March 2025}} Methamphetamine-induced psychosis is likely gated by genetic vulnerability, which can produce long-term changes in brain neurochemistry following repetitive use.<ref>{{cite journal | vauthors = Greening DW, Notaras M, Chen M, Xu R, Smith JD, Cheng L, Simpson RJ, Hill AF, van den Buuse M | display-authors = 6 | title = Chronic methamphetamine interacts with BDNF Val66Met to remodel psychosis pathways in the mesocorticolimbic proteome | journal = Molecular Psychiatry | volume = 26 | issue = 8 | pages = 4431–4447 | date = August 2021 | pmid = 31822818 | doi = 10.1038/s41380-019-0617-8 | url = https://www.nature.com/articles/s41380-019-0617-8 | access-date = 2020-01-05 | url-status = live | s2cid = 209169489 | archive-url = https://web.archive.org/web/20200806232220/https://www.nature.com/articles/s41380-019-0617-8 | archive-date = 2020-08-06 }}</ref> Methamphetamine users with more ADHD-related behaviours in childhood experience methamphetamine-related psychosis more frequently.<ref>{{Cite journal |last1=Salo |first1=Ruth |last2=Fassbender |first2=Catherine |last3=Iosif |first3=Ana-Maria |last4=Ursu |first4=Stefan |last5=Leamon |first5=Martin H |last6=Carter |first6=Cameron |date=2013-12-15 |title=Predictors of methamphetamine psychosis: History of ADHD-relevant childhood behaviors and drug exposure |journal=Psychiatry Research |volume=210 |issue=2 |pages=529–535 |doi=10.1016/j.psychres.2013.06.030 |pmid=23896355 |pmc=3818411 |issn=0165-1781}}</ref>

==== Psychedelics ====
A 2024 meta-analysis found an incidence of psychedelic-induced psychosis at 0.002% in population studies, 0.2% in uncontrolled clinical trials, and 0.6% in randomised controlled trials.<ref>{{Cite journal |last1=Sabé |first1=Michel |last2=Sulstarova |first2=Adi |last3=Glangetas |first3=Alban |last4=De Pieri |first4=Marco |last5=Mallet |first5=Luc |last6=Curtis |first6=Logos |last7=Richard-Lepouriel |first7=Héléne |last8=Penzenstadler |first8=Louise |last9=Seragnoli |first9=Federico |last10=Thorens |first10=Gabriel |last11=Zullino |first11=Daniele |last12=Preller |first12=Katrin |last13=Böge |first13=Kerem |last14=Leucht |first14=Stefan |last15=Correll |first15=Christoph U. |date=November 2024 |title=Reconsidering evidence for psychedelic-induced psychosis: an overview of reviews, a systematic review, and meta-analysis of human studies |journal=Molecular Psychiatry |language=en |volume=30 |issue=3 |pages=1223–1255 |doi=10.1038/s41380-024-02800-5 |pmid=39592825 |issn=1476-5578|pmc=11835720 }}</ref> This meta-analysis found that in uncontrolled clinical trials involving only patients with schizophrenia, 3.8% developed prolonged psychotic reactions. A 2024 study found that [[psychedelic]] use was not generally associated with a change in the number of psychotic symptoms.<ref>{{Cite journal |last1=Honk |first1=Ludwig |last2=Stenfors |first2=Cecilia U. D. |last3=Goldberg |first3=Simon B. |last4=Hendricks |first4=Peter S. |last5=Osika |first5=Walter |last6=Dourron |first6=Haley Maria |last7=Lebedev |first7=Alexander |last8=Petrovic |first8=Predrag |last9=Simonsson |first9=Otto |date=2024-04-15 |title=Longitudinal associations between psychedelic use and psychotic symptoms in the United States and the United Kingdom |journal=Journal of Affective Disorders |volume=351 |pages=194–201 |doi=10.1016/j.jad.2024.01.197 |pmid=38280572 |pmc=10922895 |issn=0165-0327}}</ref> This study found that psychedelic use interacted with a family history of bipolar disorder, such that in those with a family history of bipolar disorder, psychedelic use was associated with an increase in the number of psychotic symptoms, while in those with a personal history of psychosis but no family history of psychotic disorders, psychedelic use was associated with a decrease in the number of psychotic symptoms. A 2023 study found an interaction between lifetime psychedelic use and family history of psychosis or bipolar disorder on psychotic symptoms over the past two weeks. Psychotic symptoms were highest among individuals with both a family history of psychosis or bipolar disorder and lifetime psychedelic use, while they were lowest among those with lifetime psychedelic use but no family history of these disorders.<ref>{{Cite journal |last1=Simonsson |first1=Otto |last2=Goldberg |first2=Simon B. |last3=Chambers |first3=Richard |last4=Osika |first4=Walter |last5=Simonsson |first5=Charlotta |last6=Hendricks |first6=Peter S. |date=2023-10-24 |title=Psychedelic use and psychiatric risks |journal=Psychopharmacology |language=en |doi=10.1007/s00213-023-06478-5 |issn=1432-2072 |pmc=11039563 |pmid=37874345}}</ref>